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Annotated Bibliography of Research Related to Systemic Nickel Allergy Syndrome (SNAS) Joanne Treurniet Rebelytics R&D Inc

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Annotated Bibliography of Research Related to Systemic Nickel Allergy Syndrome (SNAS) Joanne Treurniet Rebelytics R&D Inc Annotated Bibliography of Research Related to Systemic Nickel Allergy Syndrome (SNAS) Joanne Treurniet Rebelytics R&D Inc. 7 September 2019 In this SNAS bibliography, my annotations highlight what I found relevant. I encourage you to read the original works and form your own interpretations. If a reference says “Abstract only”, it means I could not find an open source version of the full text (which also means I may be missing relevant details in my interpretation). 1. SNAS and Nickel SCD Review Articles Ahlström, M.G. et al., 2019. Nickel allergy and allergic contact dermatitis: a clinical review of immunology, epidemiology, exposure and treatment. Contact Dermatitis, 1 -15. Available at https://onlinelibrary.wiley.com/doi/full/10.1111/cod.13327 - A very good review of nickel allergy that includes both systemic and contact forms, but only discusses dermatitis as a symptom. Bergman, D. et al., 2016. Low nickel diet: A patient-centered review. Journal of Clinical and Experimental Dermatology Research, 7(355), p.2. Available at https://www.longdom.org/open-access/low-nickel-diet-a-patientcentered-review-2155-9554-1000355.pdf - Review article, defines SNAS, SCD and ACD, describes a low nickel diet, reviews the literature regarding underlying immunology and hyposensitization treatment. Goldenberg, A. and Jacob, S.E., 2015. Update on systemic nickel allergy syndrome and diet. European Annals of Allergy and Clinical Immunology, 47(1), pp.25-26. Available at http://www.eurannallergyimm.com/cont/journals-articles/352/volume-update-systemic-nickel-allergy-syndrome- 938allasp1.pdf - Letter to the editor regarding Pizzutelli’s 2011 paper, disputing its claim that SNAS is “controversial”. - Provides a good definition of SNAS and a summary of its pathophysiology. Calogiuri, G.F. et al., 2014. Nickel hypersensitivity: A general review on clinical aspects and potential co-morbidities. Journal of Allergy and Therapy, 7, p.243. Available at https://www.longdom.org/open-access/nickel-hypersensitivity-a-general-review-on-clinical-aspects-and-potenti alcomorbidities-2155-6121-1000243.pdf - A review of SNAS research dating back to 1975. Discusses symptoms, implants, food, dental materials. - Defines 5 patterns of nickel sensitization: 1. Prolonged contact/ACD 2. Occupational respiratory exposure 3. Gastrointestinal route (foods containing Ni): SNAS 1° type 4. Implants containing Ni, including stents, pacemakers, dental materials, prostheses, needles: SNAS 2° type 5. A combination of the above routes. Lampel, H.P. and Silvestri, D.L., 2014. Systemic contact dermatitis: current challenges and emerging treatments. C urrent Treatment Options in Allergy, 1(4), pp.348-357. Available at https://link.springer.com/article/10.1007/s40521-014-0029-6 - Review article on SCD that includes SNAS. Fabbro, S.K. and Zirwas, M.J., 2014. Systemic contact dermatitis to foods: nickel, BOP, and more. Current Allergy and Asthma Reports , 1 4( 10), p.463. Available at http://www.aaifnc.org/Documents/symposium_2018/addendum/SystemicContactDiet2.pdf - A review of SCD to several food-borne allergens: nickel, cobalt, chromium, BoP, PG, urushiol, sesquiterpene lactones, formaldehyde, garlic, propolis and sorbic acid. - Says SCD is completely unrelated to type I (IgE) allergies, contrary to some other work. - Classic presentation of SCD to nickel is hand dermatitis, itchy papules on the elbows and/or knees, and “widespread symmetric macropapular eruptions”. Reappearance of prior sites of ACD in the absence of cutaneous exposure should strongly suggest SCD. - Includes a table of common presentations for each allergen. Katta, R. and Schlichte, M., 2014. Diet and dermatitis: food triggers. The Journal of Clinical and Aesthetic Dermatology, 7(3), p.30. Available at h ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970830/ - A review article on ACD and SCD that includes nickel. - Lists treatments including diet and lifestyle changes to reduce nickel exposure, along with the other top contact allergens. Sharma, A.D., 2013. Low nickel diet in dermatology. Indian Journal of Dermatology, 58(3), p.240. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667300/ - A review of nickel allergy as a cause of dermatitis and its treatment via a low nickel diet. - Covers food and non-food sources of nickel and non-dietary treatments. Yoshihisa, Y. and Shimizu, T., 2012. Metal allergy and systemic contact dermatitis: an overview. Dermatology Research and Practice, 2012 . Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369403/ - A review of metal SCD with a section on nickel. - Proposes using a blood test that measures Th1 and Th2 cytokine production to confirm the diagnosis of metal allergies. Tammaro, A. et al., 2011. Topical and systemic therapies for nickel allergy. Dermatitis, 22(5), pp.251-255. Available at https://pdfs.semanticscholar.org/8cea/8ea8633725f4b1c96a070e026c285d1ac846.pdf - A review article of treatments for SNAS, including topical, UVB, systemic immunosuppressive, zinc, low nickel diet, disulfiram, and hyposensitization therapies. Pizzutelli, S., 2011. Systemic nickel hypersensitivity and diet: myth or reality? European Annals of Allergy and Clinical Immunology , 43(1), p.5. Available at http://www.eurannallergyimm.com/cont/journals-articles/211/volume-systemic-nickel-hypersensitivity-diet-myth- 563allasp1.pdf - A very critical review of the SNAS literature up to 2011 that questions studies that support food-borne nickel as a symptom source and the low nickel diet as a treatment. - Has a table demonstrating how variable the advice is from 11 different sources. - Provides a good description of SNAS and SCD. - Discusses how difficult it is to rigorously test for SNAS because nickel is ubiquitous, which makes double-blind testing difficult as consumed nickel is uncontrolled, and scoring is subjective. - Concludes that more rigorous studies need to be done to establish that nickel allergy is indeed responsible for SNAS symptoms. - Claims there is a “strong psychosomatic effect”, with no citations to support the statement. Petrucci, F., Bocca, B., Forte, G., Caimi, S. and Cristaudo, A., 2009. Role of diet in nickel dermatitis. The Open Chemical and Biomedical Methods Journal, 2 , pp.55-7. Available at https://benthamopen.com/contents/pdf/TOCBMJ/TOCBMJ-2-55.pdf - A review of SCD and nickel sources, including dietary, and treatments. Thyssen, J.P. and Maibach, H.I., 2008. Drug‐elicited systemic allergic (contact) dermatitis–update and possible pathomechanisms. C ontact Dermatitis, 59( 4), pp.195-202. Available at http://www.academia.edu/download/46171308/j.1600-0536.2008.01367.x20160602-32360-3rbc9o.pdf - A review of SCD to metals and drugs. - Lists 10 different terms used in the literature for SCD, not including SNAS. - SCD is a type 3 and 4 allergy, and the initial immune reactions may take place in both the skin and gastrointestinal mucosa. Metal allergies are Th1 and Th2 driven. - Recommends using the term Systemic Allergic Dermatitis (SAD) instead of SCD since contact is not a requirement. [I would propose Systemic Allergy Syndrome (SAS) since dermatitis isn’t always a symptom either!] - Systemic symptoms of SAD include headaches, fever, malaise, arthralgia, vomiting and diarrhea. - Patch testing should not be done prior to 6 weeks of an adverse reaction. Negative patch testing should be followed up with intradermal testing. The LTT is a useful adjunct test. Jensen, C.S., Menné, T. and Duus Johansen, J., 2006. Systemic contact dermatitis after oral exposure to nickel: a review with a modified meta‐ a nalysis. Contact Dermatitis, 54(2), pp.79-86. Available at https://www.researchgate.net/profile/Christian_Jensen26/publication/7290411_Systemic_contact_dermatitis_af ter_oral_exposure_to_nickel_A_review_with_a_modified_meta-analysis/links/5be143d892851c6b27aa2db1/Sy stemic-contact-dermatitis-after-oral-exposure-to-nickel-A-review-with-a-modified-meta-analysis.pdf - Meta-analysis of 9 studies finding that for patients with SCD or chronic eczema, 1% will react to oral nickel doses less than 0.22mg using the more “sensitive” findings, which is a normal dietary exposure rate. 2. Low Nickel Diets and Dietary Treatment Studies Rizzi, A. et al., 2017. Irritable Bowel Syndrome and nickel allergy: What is the role of the low nickel diet? Journal of Neurogastroenterology and Motility , 23(1), p.101. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216640/ - Patients with IBS and all other causes ruled out and a positive nickel patch test (20 of them) were put on the BraMa-Ni low nickel diet for 3 months. - There was significant improvement in all subjective GI symptoms, but the overall health survey didn’t differ significantly. - The intestinal permeability improved more for patients with moderate to severe skin reactions, and worsened for half of the patients. - Confirms the high prevalence of anxiety and other psychological symptoms. Antico, A. and Soana, R., 2015. Nickel sensitization and dietary nickel are a substantial cause of symptoms provocation in patients with chronic allergic-like dermatitis syndromes. Allergy & Rhinology, 6(1), p.e56. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388878/ - Of 1726 patients with chronic allergic-like skin diseases, none had extracutaneous (SNAS) symptoms. This may be because any patient with an IgE allergy to anything was excluded. - 339 (20%) tested nickel positive, and 52 recovered by avoiding contact with nickel. - 207 achieved complete or near complete recovery by following their low-nickel diet (list included). The diet was ineffective for 51. - 185 had a positive oral challenge (on an empty stomach); in 26 the response was severe. Average time of reaction to challenge was 5.3 ± 2.5 hours, ranging from 3 to 12 hours. Perez, L.D.M., França, A.T. and Zimmerman, J.R., 2015. Systemic nickel allergy syndrome, World Allergy Organization Journal, 8(S1), p.A89. Available at https://waojournal.biomedcentral.com/articles/10.1186/1939-4551-8-S1-A89 - Very brief overview of a Brazilian SNAS study with some language clarity issues. - 331 patients with SNAS symptoms improved after 60 days on a low nickel diet; for those who went back to their regular diet, symptoms returned between 7 and 20 days.
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